Chest
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Case Reports
Two-dimensional echocardiographic abnormalities of right atrial metastatic tumors in hepatoma.
We describe two patients suffering from hepatoma who presented with right atrial metastatic tumors as a result of invasion of the inferior vena cava and extension into the right atrium. Two-dimensional echocardiographic studies detected the right atrial tumor during life in both patients and the invasion of the inferior vena cava in one patient.
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Case Reports
Bronchial atresia associated with a bronchogenic cyst. Evidence of early appearance of atretic segments.
We report a case of congenital lobar emphysema in an adult due to bronchial atresia and presenting characteristically with a solitary pulmonary nodule due to a mucous plug. In the same patient the presence of a bronchogenic cyst leads to a hypothesis that the atretic segment is the result of an insult occurring during the 5th or 6th week of intrauterine life rather than one occurring after airway development is complete.
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Ten otherwise healthy cigarette smokers (mean, 31 cigarettes per day), and ten nonsmoking control volunteers matched for age, weight, and sex received single intravenous doses of diazepam (5 to 10 mg), midazolam (5 mg), and lorazepam (2 mg) on three separate occasions. Kinetics of each benzodiazepine were determined from multiple serum concentrations measured after each dose. In non-smoking vs smoking subjects, there was no significant difference in mean clearance of diazepam (0.44 vs 0.47 ml/min/kg), midazolam (9.6 vs 7.1 ml/min/kg), or lorazepam (0.96 vs 1.08 ml/min/kg). Thus, differences in pharmacokinetics are unlikely to account for altered sensitivity to benzodiazepines that may occur in cigarette smokers.
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Medicare prospective payment by diagnosis-related groups (DRGs) has intensified the debate over the use and costs of medical technology. In this study, we examine the financial impact of DRG payment for medicare patients receiving medical intensive care. During a one-year period, payment for 446 Medicare patients receiving medical intensive care at a large teaching hospital was calculated to be +4.7 million below costs, representing an average loss per discharge of +10,567. ⋯ For this group, the average payment per discharge was projected to be +21,651 below the average per discharge cost. We conclude that the results send strong financial messages to hospitals providing medical intensive care to severely ill, elderly patients. Further exploration and research must occur to ensure hospital responses will be consistent with public policy expectations.